Hi there,

I got my last problem figured out - intestinal blockage! Now that everything is back to normal there, I'd like to ask for advice about fatigue.

I'm 5 months out and have some pretty extreme fatigue. If I don't take my stay awake medicine (150 mg nuvigil) and have coffee in the afternoon I simply can't keep my eyes open/start seeing double. I often go home and fall asleep right after dinner. I recently had some bloodwork done and am not deficient in any Vitamins, no thyroid problems. I also have a number of dizzy episodes every day, mostly when I get up too fast. Could this be because I take a beta blocker to prevent migraines? Maybe my dose needs to be adjusted - too low of blood pressure? I don't really mind the dizziness, but I can't be this tired! I don't have the energy to work as hard as I used to or to do any sort of exercise beyond being on my feet all day teaching. Some mornings I have to sit down in my classroom because, whew, I think I might keel over if I stand any longer. I have been tracking my calories and am getting about 500-700 a day. At 5 months out, should I be eating more calories? Help! I don't have the energy to keep up with my life!

-Hilary

Though medications could be an issue, you are definitely not eating enough calories. Your body is shutting down because it doesn't even have enough energy to get through the day. I would try upping it to 800 to 1000 calories. Still eating the 6 small meals throughout the day. Also, how much Protein are you getting in a day? Increasing the amount of protein can also help.

There is a delicate balance between the number of calories you eat in a day and the number of calories you work off. I suggest religiously tracking both using a FitBit or other activity and calorie tracking device. After a few weeks you will discover what your sweet spot is. You definitely want to burn more calories than you take in, but you also don't want to not not have the energy to make it through the day which is what is happen in your case more than likely.

The other thing is that when your calorie count is so low, your body will think it is in starvation mode and actually start storing fat instead of using it. I went through a period of 3 months where I lost nothing because I was working out really heavily and not adjusting my calories up just a little to make up for it.

If you have any additional question or I can help in any way, please let me know.

Your calorie intake is low specially as a teacher as you are on your feet and moving a lot. I think you may have to manage your blood sugar levels more closely. I am not sure if you just do your 3 meals a day. I do 3 meals and an afternoon snack. But I find that diluted unsweetened apple juice (1/3 apple and 2/3 water) helps a lot when I feel a little tired spell coming. Also monitor your protein intake and make sure you are getting the 60 grs. I am not a doctor but you description sounds like low blood sugar.

I'm having the same problem! Go in for 6 month check next week to have Vitamin levels etc. checked. Love the weight loss but the "tired all the time" thing is getting old! Depression feels like it's settling in :-(

I've been trying to up my calories. Most days I come in right at about 700. Some days I can get in 1000. The fatigue is still present. I am sometimes falling asleep at lunch. I am really hesitant to try to get more calories than my body wants naturally. I'm afraid that will lead to bad habits. But, I feel that it must be necessary because my weight loss has stalled out. I don't think my body wants to give up any more fat right now. I never imagined I'd have this problem. I'm part stuck in a mental game where I'm scared to eat more and part stuck physically where I just don't want to eat more. I wish my surgeons office wasn't 4 hours away. Really feeling like I could use some support!

I'm having the same problem! Go in for 6 month check next week to have vitamin levels etc. checked. Love the weight loss but the "tired all the time" thing is getting old! Depression feels like it's settling in :-(

Rome, let me know when you get answers!

HilaryinRC,

Just to let you know that one very common side effect of betablockers is fatigue. You should check with your doctor. They may need to change your dose or medication all together. Best of luck!

I take provigil. I have both sleep apnea and narcolepsy. If you are taking nuvigil for sleep apnea you may need to get the air pressure level adjusted or check on your nuvigil dosage level. It also sounds like your blood sugar level is dropping too low. I only get 600 to 800 calories a day. I know I should get more but I struggle to get in what I do so I won't tell you the obvious eat more as I know that may not be possible. I have to spread it out where I eat something every couple of hours. even if it is just a bite of cheese. A lentil cracker with a spoonful of tuna. This helps with blood sugar balance. Are you getting your water in? How are your electrolytes? My doctor actually advised me to drink one G2 gatorade a day. Yes actual sugar. Once I started adding the extra electrolytes I started feeling much better.

More calories. Also medications have side effects. You are taking meds I would look into them. Medications are not

Our friends. Consider finding other ways to treat or stave off your migraine.

Also caffeine can both dehydrate you and make you tired. Try getting rid of the coffee and drinking more Water.

Your "stay awake" medicine sounds pretty scary. You need restful

sleep, a good schedule, more high

Quality calories and to get rid of the meds.

Also the dizziness can be caused by an inner ear infection and or allergies.

But I would look into the meds first off and get seriously thinking about the long term safety and purpose of a medication.

We often bandaid ourselves with meds only to trade one problem for a host of others.

I too take meds to keep migraine severe migraines at bay. I have noticed since I have lost my first 50 lbs that I was feeling very lethargic and tired. I am only 7 weeks out so of course I am assuming this has a lot to due with just getting better from surgery. I actually had to go in and have my Vitamin levels checked out this week to make sure because it got so bad there were a couple of times I thought I was going to pass out.

The meds they were giving me to keep my migraines at bay was actually now causing a low blood pressure and heart rate because of my weight loss. The good news was, I had not had a migraine since my surgery.

The bad news, I have been off the meds for the last two days and it is taking my body a lot to get use to this much faster heart rate. I am very jittery, I can feel my heart in my ears (it is normal, I have taken my blood pressure several times a day).

And of course yesterday I had a migraine. YUCK!

I am hoping my body is just getting used to not having this drug in my system. I am definitely NOT relaxed and clenching my jaw. I was only on a low dose of Propanol but I think we should have cut it in half instead of just stopping it.

Anyway......I do think that those meds can cause some of the symptoms you are describing.

I would check with your doctor right away but make sure there is a plan to wean you off if that is what they decide to do.

Good Luck and keep us posted!

Hi-- you might want to consider Botox for migraine instead of the meds. I am 21 months post RNY and love the Botox. It is really good at preventing migraines and my forehead is wrinkle free!

And you may want to have a few mini snacks during the day to help with fatigue. That did the trick for me and helped stabilize my blood sugar. Hope you feel better!

I still think you need more Water NOT coffee. I hope you are feeling better.

Also excessive can really help fatigue. When your metabolism gets burning you will feel a rush of energy, and it also tells your body to burn fat, not burn glucose, which creates a better energy source for you body and weight loo as well. It's the best thing you can do for fatigue. Excessive in the morning first thing and you will double your energy all day.

Hi everyone,

Thank you for your responses. You all have great advice, which I've mostly taken - more Water, more calories, more Protein etc. I've started really paying attention to the fatigue and I've noticed an important pattern. It is only after I eat lunch and dinner that I feel the extreme fatigue. I get so tired that I either go to sleep or nearly go to sleep. The other day I had an English muffin with Peanut Butter (I was so hungry I nearly ate the whole thing) and ended up in a "food coma" - I fell asleep for 3 hours! I'm finding that if I have anything heavier than just a Protein Drink, little bit of meat, or salad/veggies/fruit with cheese that I feel that fatigue. My aunt is a retired RN and having witnessed me eat this week has said she thinks my body is releasing too much insulin, which is knocking me out after eating. She has encouraged me to take my blood sugar before eating and then during the slump after to see what is going on - I will do this next time I eat a heavier meal (which, for the first time ever, wasn't Thanksgiving! - salad and turkey for dinner here). She thinks my body just doesn't understand how much insulin I need, but that it will get better as my body adjusts more to my new eating habits. That being said, I have an appointment with both the sleep doctor and my bariatric nurse on December 10th. Hopefully, they will be able to shed more light on what is happening. And, finally, I'm thinking I should schedule an appointment with my nutritionist too.

Thoughts? Has this happened to anyone else? Does anyone know how to better control insulin?

-Hilary

Hi-- you might want to consider Botox for migraine instead of the meds. I am 21 months post RNY and love the Botox. It is really good at preventing migraines and my forehead is wrinkle free!

And you may want to have a few mini Snacks during the day to help with fatigue. That did the trick for me and helped stabilize my blood sugar. Hope you feel better!

Hi Sassy,

I'd love to get Botox for migraine! It would be great to be free of the beta blocker. Does your insurance cover it? I'm a teacher and still an intern, so money is a bit tight. Could you tell me more about your experience with Botox? How long until it started working? How often do you get the injections? Is it as effective for you as proflactic meds?

-Hilary

I too take meds to keep migraine severe migraines at bay. I have noticed since I have lost my first 50 lbs that I was feeling very lethargic and tired. I am only 7 weeks out so of course I am assuming this has a lot to due with just getting better from surgery. I actually had to go in and have my Vitamin levels checked out this week to make sure because it got so bad there were a couple of times I thought I was going to pass out.

The meds they were giving me to keep my migraines at bay was actually now causing a low blood pressure and heart rate because of my weight loss. The good news was, I had not had a migraine since my surgery.

The bad news, I have been off the meds for the last two days and it is taking my body a lot to get use to this much faster heart rate. I am very jittery, I can feel my heart in my ears (it is normal, I have taken my blood pressure several times a day).

And of course yesterday I had a migraine. YUCK!

I am hoping my body is just getting used to not having this drug in my system. I am definitely NOT relaxed and clenching my jaw. I was only on a low dose of Propanol but I think we should have cut it in half instead of just stopping it.

Anyway......I do think that those meds can cause some of the symptoms you are describing.

I would check with your doctor right away but make sure there is a plan to wean you off if that is what they decide to do.

Good Luck and keep us posted!

Thank you for this info! I take propanalol 60 mg 2x day to prevent migraine. I'm am pretty sure that is what is behind the dizziness. I'm a bit nervous to switch off of it because I don't want the migraines back and when I miss a dose of propanalol, I get the racing heart too! If I go off, I will definitely wean myself down and not go cold turkey. I think I should talk to my doctor about those Botox shots! Wouldn't it be great to get some injections every so often and be off the propanalol completely?